Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2019013854 | MO |
N | 103K00000X | Behavior Analyst | 220 | KS |
NPI | 1003472275 |
---|---|
Provider Name | Ms. Smile Junalilz Baluran Lucero |
First Address | Kansas City, MO 64137-1618 |
Second Address | Kansas City, MO 64137-1618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2019 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2019013854 | STATE LICENSE (01) | MO |